TennCare Fair Hearing: How to Appeal a Denied Medicare Savings Program Application

TennCare denied your parent's Medicare Savings Program application, and the notice says something about income exceeding the limit or assets being too high. Before accepting the decision, check the math. Common errors — failing to apply the $20 income disregard, miscounting liquid resources, or not recognizing an ex-parte renewal submission — are frequent enough that a well-prepared appeal has a real chance of reversal.

The 40-Day Deadline

Your parent or their authorized representative has 40 calendar days from the date printed on TennCare's Notice of Eligibility to request a State Fair Hearing. That deadline is strict — if no appeal is filed within 40 days, the decision becomes final and TennCare loses administrative jurisdiction to reconsider it.

The 40 days starts from the date on the notice, not the day your parent receives it. If mail delivery took a week, you've already lost a week.

Continuation of Benefits (Aid Paid Pending)

If your parent was already enrolled in QMB, SLMB, or QI and TennCare sends a notice of termination or reduction, there's a tighter deadline: 10 calendar days from the notice date to request an appeal and demand continuation of benefits.

If you request continuation within that 10-day window and it is granted, TennCare continues the Medicare premium buy-in and any applicable cost-sharing coverage until the hearing officer makes a final decision. If you miss the 10-day window but file within 40 days, the appeal proceeds but benefits stop during the hearing process.

One risk to weigh: if TennCare's decision is upheld at the hearing, the state may seek recovery of premiums paid during the continuation period, as described in the notice.

How to File

Appeals can be submitted three ways:

• Online through TennCare Connect at tenncareconnect.tn.gov
• Phone at 1-855-259-0701
• Mail or fax to TennCare Appeals Division, P.O. Box 305240, Nashville, TN 37230-5240 (fax: 1-855-315-0669)

A written statement is strongest. Include:

• Your parent's name, TennCare case number, and the date on the denial notice
• The specific reason you believe the denial was wrong
• Supporting documents — a corrected income calculation, bank statements showing assets under the limit, or proof that TennCare didn't apply the $20 disregard

What Happens at the Hearing

State Fair Hearings are conducted by independent Hearing Officers from the Tennessee Department of State's Administrative Procedures Division — not by TennCare employees. The hearing officer cannot be someone who reports to the TennCare eligibility unit.

Your parent or their representative has the right to:

• Inspect the complete TennCare case file before the hearing
• Submit documentary evidence
• Present witness testimony
• Cross-examine the state's eligibility specialist

Hearings can be conducted in person or by phone. Most MSP hearings are relatively straightforward — they hinge on the income or asset calculation, and the dispute is usually about whether TennCare correctly applied the disregards or properly categorized a resource.

Common Grounds for Appeal

Incorrect income calculation. TennCare must apply the $20 monthly unearned income disregard before comparing countable income with the FPL threshold. If your parent's gross Social Security is $1,350, the $20 disregard leaves $1,330 in countable income, at 100% of the 2026 single-person FPL. If TennCare denied QMB at that figure, review its calculation.

Miscounted resources. The primary home, one vehicle, personal belongings, and up to $1,500 per person in designated burial funds are excluded. If TennCare included any of these in the asset count, the calculation is wrong.

Missed renewal submission. If your parent returned the renewal packet but TennCare's system didn't register receipt, the 90-day reconsideration grace period applies. Evidence of submission — a fax confirmation, certified mail receipt, or TennCare Connect upload timestamp — can reverse a procedural closure.

Free Legal Help

Low-income seniors in Tennessee can get free representation for MSP fair hearings from:

• Legal Aid Society of Middle Tennessee and the Cumberlands: 1-800-238-1443
• Memphis Area Legal Services (West TN): 1-800-723-7455
• Legal Aid of East Tennessee: 1-860-523-8822
• West Tennessee Legal Services: 1-800-372-8346

For the full appeal process, document checklist, and income calculation worksheets, see the Tennessee Medicare Savings Programs & Extra Help Guide.

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